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Percutaneous Coronary Intervention: Clinical Updates and Perspectives
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Percutaneous Coronary Intervention: Clinical Updates and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 22 December 2024 | Viewed by 2821

Special Issue Editor

Dr. Iosif Xenogiannis

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Guest Editor
1. Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
2. Department of Cardiology, Mitera General Hospital, 151 23 Athens, Greece
Interests: coronary artery disease; atherosclerosis; coronary intervention; myocardial infarction; sudden cardiac death; takotsubo cardiomyopathy

Special Issue Information

Dear Colleagues,

It has been more than 40 years since the first percutaneous coronary angioplasty (PCI) was performed. Since then, significant advances in the field of interventional cardiology have been accomplished. In contemporary clinical practice, radial artery is considered the safest site for access, substituting the femoral artery as the by-default option for gaining access. Intracoronary imaging (intravascular ultrasound and optical coherence tomography)-guided PCI has been associated with better outcomes compared to conventional PCI. Whether the functional assessment of lesions is beneficial for the patient or not is contested, with both positive and negative studies published recently. New cutting-edge devices have been added to the armamentarium of the interventional cardiologist, facilitating PCI and improving its results. Intravascular lithotripsy is a safe and effective option for the preparation of severely calcified lesions. New-generation stent platforms have reduced the rates of in-stent restenosis, and they have overcome first-generation drug-eluting stents’ Achilles hill, namely stent thrombosis, while drug-eluting balloons aspire to overcome stent-related complications by leaving no material in the patient's coronary artery tree. Although complete revascularization in the setting of myocardial infarction should be the ultimate goal of every interventional cardiologist, the impact of PCI on hard endpoints concerning stable coronary artery disease is under dispute.

Dr. Iosif Xenogiannis
Guest Editor

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Keywords

  • percutaneous coronary intervention (PCI)
  • intravascular ultrasound (IVUS)
  • optical coherence tomography (OCT)
  • radial access
  • drug-eluting balloons (DEB)
  • drug-eluting stents (DES)

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Published Papers (2 papers)

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Research

14 pages, 2074 KiB  
Article
Clinical Impact of Intracoronary Imaging in the Management of Stent Thrombosis
by Grigoris V. Karamasis, Athanasios Katsikis, Klio Konstantinou, Gerald J. Clesham, Paul A. Kelly, Rohan Jagathesan, Francesco Prati, Christos V. Bourantas, John R. Davies and Thomas R. Keeble
J. Clin. Med. 2024, 13(16), 4667; https://doi.org/10.3390/jcm13164667 - 9 Aug 2024
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Abstract
Objectives: Use of intracoronary imaging (ICI) in cases of stent thrombosis (ST) is recommended and tailored treatment appears reasonable. Nevertheless, data supporting such a strategy are lacking. The aim of this study was to evaluate the clinical impact of ICI in the management [...] Read more.
Objectives: Use of intracoronary imaging (ICI) in cases of stent thrombosis (ST) is recommended and tailored treatment appears reasonable. Nevertheless, data supporting such a strategy are lacking. The aim of this study was to evaluate the clinical impact of ICI in the management of ST. Methods: The unadjusted study population was consecutive patients with definite ST presenting in a single tertiary cardiac centre and undergoing percutaneous coronary intervention (PCI). The presumed major mechanism of ST was assigned according to the real-time ICI interpretation by the PCI operator. Propensity score matching was performed with regard to ICI use to form the adjusted population and Kaplan–Meier analysis was applied to compare survival free of cardiac death (CD) or target lesion revascularization (TLR). Results: The unadjusted population included 130 ST patients, with the majority presenting with ST-elevation myocardial infarction (STEMI) (88%) and very late ST (86%). ICI was performed in 45 patients, of whom optical coherence tomography (OCT) was performed in 30 cases. When the individual ST mechanisms were viewed as groups, there was an interaction observed between type of treatment (stent vs. non-stent) and ST mechanism, with non-stent treatment being more prevalent in cases of underexpansion, malapposition, in-stent restenosis and mechanism uncertainty. After application of matching, two groups of 30 patients were formed. ICI-guided management resulted in better survival free of CD–TLR at 2 years (93% vs. 73%, p = 0.037). Conclusions: Intracoronary imaging guidance during PCI for ST had a direct impact on management (stent vs. non-stent) and resulted in a lower event rate at mid-term follow-up when propensity matched analysis was applied. Full article
(This article belongs to the Special Issue Percutaneous Coronary Intervention: Clinical Updates and Perspectives)
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11 pages, 1706 KiB  
Article
Impact of Drug-Coated Balloon-Based Revascularization in Patients with Chronic Total Occlusions
by Eun-Seok Shin, Ae-Young Her, Mi Hee Jang, Bitna Kim, Sunwon Kim and Houng Bang Liew
J. Clin. Med. 2024, 13(12), 3381; https://doi.org/10.3390/jcm13123381 - 9 Jun 2024
Viewed by 1279
Abstract
Background: Percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) for chronic total coronary occlusions (CTOs) improves clinical symptoms and quality of life. However, data on drug-coated balloon (DCB)-based PCI in CTO lesions are limited. Methods: A total of 200 patients were successfully [...] Read more.
Background: Percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) for chronic total coronary occlusions (CTOs) improves clinical symptoms and quality of life. However, data on drug-coated balloon (DCB)-based PCI in CTO lesions are limited. Methods: A total of 200 patients were successfully treated for CTO lesions, either with DCB alone or in combination with DES (DCB-based PCI). They were compared with 661 patients who underwent second-generation DES implantation for CTO from the PTRG-DES registry (DES-only PCI). The endpoint was major adverse cardiovascular events (MACEs), which included a composite of cardiac death, myocardial infarction, stent or target lesion thrombosis, target vessel revascularization, and major bleeding at 2 years. Results: In the DCB-based PCI group, 49.0% of patients were treated with DCB only and 51.0% underwent the hybrid approach combining DCB with DES. Bailout stenting was performed in seven patients (3.5%). The DCB-based PCI group exhibited fewer stents (1.0; IQR: 0.0–1.0 and 2.0; IQR: 1.0–3.0, p < 0.001), shorter stent lengths (6.5 mm; IQR: 0.0–38.0 mm and 42.0 mm; IQR: 28.0–67.0 mm, p < 0.001), and lower usage of small stents with a diameter of 2.5 mm or less (9.8% and 36.5%, p < 0.001). Moreover, the DCB-based PCI group had a lower rate of MACEs than the DES-only PCI group (3.1% and 13.2%, p = 0.001) at 2-year follow-up. Conclusions: The DCB-based PCI approach significantly reduced the stent burden, particularly in the usage of small stent diameters, and resulted in a lower risk of MACEs compared to DES-only PCI in CTO lesions. Full article
(This article belongs to the Special Issue Percutaneous Coronary Intervention: Clinical Updates and Perspectives)
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